Nosocomial influenza: new concepts and practice

Abstract

Nosocomial influenza constitutes a serious risk among patients with underlying diseases and those of extreme age, and is associated with excess health-care costs. This article will review recent literature on this area. Despite longstanding recommendations and the fact that influenza vaccination of health-care workers improves patient and employee safety, vaccine coverage among health-care workers remains low worldwide. The Centers for Disease Prevention and Control recommends the use of signed declination forms for those health-care workers who refuse vaccination. Rapid antigen detection tests may accurately diagnose influenza at the point of care, and their use has been associated with reduced antibiotic use, diagnostic tests, and costs. Multiplex molecular methods may simultaneously detect several respiratory viruses and might prove advantageous for surveillance within hospitals. The beginning of the 2007-2008 influenza season was marked by the detection of a significant proportion of influenza A/H1N1 viruses resistant to oseltamivir in Europe. Given the prohibiting rates of resistance to adamantanes worldwide, our means for containing outbreaks within health-care facilities may narrow. Provision of influenza vaccine at no cost and at the work site, education to promote vaccination, and switch to a mandatory influenza vaccination policy should be implemented in order to achieve high and sustained vaccine coverage among health-care workers. Surveillance to monitor antiviral resistance in influenza viruses should be enhanced. Development of new antivirals is needed.